Cardiovascular risk factors and incident albuminuria in screen-detected type 2 diabetes.

BackgroundIt is unclear whether cardiovascular risk factor modification influences the development of renal disease in people with type 2 diabetes identified through screening. We determined predictors of albuminuria 5years after a diagnosis of screen-detected diabetes within the ADDITION-Europe study, a pragmatic cardiovascular outcome trial of multifactorial cardiovascular risk management. MethodsIn 1826 participants with newly diagnosed, screen-detected diabetes without albuminuria, we explored associations between risk of new albuminuria (2.5mgmmol(-1) for males and 3.5mgmmol(-1) for females) and (1) baseline cardio-metabolic risk factors and (2) changes from baseline to 1year in systolic blood pressure (SBP) and glycated haemoglobin (HbA(1c)) using logistic regression. ResultsAlbuminuria developed in 268 (15%) participants; baseline body mass index and active smoking were independently associated with new onset albuminuria in 5years after detection of diabetes. In a model adjusted for age, gender, baseline HbA(1c) and blood pressure, a 1% decrease in HbA(1c) and 5-mmHg decrease in SBP during the first year were independently associated with lower risks of albuminuria (odds ratio), 95% confidence interval: 0.76, 0.62 to 0.91 and 0.94, 0.88 to 1.01, respectively. Further adjustment did not materially change these estimates. There was no interaction between SBP and HbA(1c) in relation to albuminuria risk, suggesting likely additive effects on renal microvascular disease. ConclusionsBaseline measurements and changes in HbA(1c) and SBP a year after diagnosis of diabetes through screening independently associate with new onset albuminuria 4years later. Established multifactorial treatment for diabetes applies to cases identified through screening.